Healthcare Provider Details

I. General information

NPI: 1538728472
Provider Name (Legal Business Name): LITTLE STAR PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 LINCOLN ST
EUGENE OR
97401-3695
US

IV. Provider business mailing address

6715 IVY ST
SPRINGFIELD OR
97478-7356
US

V. Phone/Fax

Practice location:
  • Phone: 541-203-6385
  • Fax: 541-727-5152
Mailing address:
  • Phone: 850-728-8158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ELISABETH MUSCH
Title or Position: LICENSED PSYCHOLOGIST
Credential: PHD
Phone: 850-728-8158